Physiology of Aging
- Changes are inevitable, people change as they age
1. Genes genes account for about 25% of longevity. People who are studying
genes today realize that people who live to 100 carry genes that give them
protection from things that kill other people. IF they identify these genes, they can
increase the longevity of people
3. Environment age related changes will be more extreme if someone was
malnourished or lived in a bad area when growing up
- Disorders (Chronic Diseases) 80% of seniors who are +65 have at least 1 chronic
disease. The big 2 are diabetes and high blood pressure. In terms of life expectancy,
many people live the last 10 years of their life in morbidity (they live the last 10 years
with a chronic disease). This is a huge healthcare cost; we spend $2 out of every $3 on
healthcare for those with chronic diseases. We’ll spend $40 billion on people with
chronic diseases while we only spend $8 billion on prevention. All chronic diseases can
be managed with a proper plan. Many seniors these days don’t have the skills (eg.
literacy skills to understand) to understand things so they aren’t as capable of managing
their chronic diseases but the baby boomers should be able to. Medicine today is all
about preventing and managing chronic diseases because medicines have already
been created. Ontario Health Study looks at 18 year olds and up and is following people
through their lifespan looking at many factors that affect each person.
- Many baby boomers are overweight and unhealthy and they are in the prime age for
heart disease. So in terms of the boomers is 60 the new 70? Are boomers going to be
the first generations of Canadians to die before their parents because of their health
1. Cardiovascular System used to be the number one killer in Canada but now
cancer is. 1 in 2 adults over 65 has some type of heart disease. Every 7 minutes
someone has a heart attack or stroke and every 8 minutes someone dies from a heart
attack. Now there are more women suffering from cardiovascular disease than men.
1. The Heart the heart muscle gets bigger, the 4 valves in the heart calcify so
the heart is inefficient at pumping through the blood. Pacemaker cells decrease
in number so a lot of older people will have slight arrhythmias. The heart takes
longer to recover (that’s why older people get tired fast). There is a decline in
2. The Veins the veins expand so the blood moves slower to the vein, which
contributes to the inefficiency of the heart. The blood can be susceptible to
clotting because it moves slower
3. The Arteries there is hardening of the arteries so they lose their elasticity and
there are fatty deposits called plaque in the arteries.
a) Risk Factors
- Non-Control Factors
2. Male Gender this is being more disputed because women after
menopause are more at risk 3. Family History you are at a higher risk if someone in your family has
had a heart attack
4. Ethnicity immigrants come to Canada with healthy hearts and they
may not have family doctors in Canada/their diet changes/they have a
more stressful lifestyle so they have a tendency to develop heart diseases.
South Asians have a tendency to get heart disease 10 years younger than
anyone else. The lowest rate of heart disease is in the Chinese.
- Control Factors
1. Smoking you can quit smoking
2. Obesity a person’s girth is the best indicator of heart disease
4. High Cholesterol control factor to a certain extent because some
bodies just produce lots of bad cholesterol
5. Diet our diets have too many trans-fats
6. Hypertension your heart is working too hard so you are more at risk for
8. Personality Type they used to say Type As have heart problems and
generally men. People who are inherently angry are also at a higher risk
9. Emotional Stress there are hormones released that affect the immune
system and it increase the heart rate
12. Poverty people who are poor; women, new immigrants, etc. maybe
don’t change their habits because it is too expensive to eat healthy
13. Pollution 6 000 deaths in Toronto are due to pollution
14. Noise increases levels of stress hormones and increases risk of
heart disease - Diagnostic Modalities for Coronary Heart Disease
- Cholesterol some people’s bodies manufacture bad cholesterol but
after the age of 40 people should get their cholesterol checked every year.
9/10 when your cholesterol is bad, the doctor will put you on a diet.
Cardiologists says that they can’t wait and see if a diet will help fix the
cholesterol problem and they think that you should be put on medications
to decrease cholesterol immediately. Others disagree.
- Electrocardiogram if you are over 40, you should have these at every
physical. These look at the pattern of the heart. From the ECG you can tell
if the heart rhythm is normal and if it is getting enough oxygen. It can also
tell you if you had a heart attack.
-They put electrodes on your arms and legs.
- Exercise Stress Test recommended for older people. Heart’s reaction
to physical activity. You are put on a bike or treadmill and your blood
pressure is monitored. This can show how your heart is functioning
relevant to activity.
- Thallium Cardiolite Scan radioactive substance (dye) is put into your
bloodstream and you basically do an exercise stress test. They can see
how much of the substance is reaching the heart and if there are
blockages. You repeat the test 4 hours later. This is good for when they
think there is a blockage
- Echocardiogram ultrasound of the heart. They can take pictures and
see if the heart is enlarged and how the valves are working.
- Transesophageal Echo Cardiogram (make you swallow camera) it
goes down throat when the valves don’t look like they’re operating
properly in an echocardiogram because the camera gets a better picture
of what’s happening with the valves
- Angiogram catheter is sent up through the groin to the heart and dye is
injected so you can see if there are any blockages and if the valves and
things are working properly.
**Technology has continued to improved and soon there will be no need
for angiograms because there will be electronic imaging available.
- Treatment for Coronary Artery Disease
- Medication least invasive. Most simplistic is aspirin, which will thin the
blood to prevent clotting. You can be put on beta-blockers to slow the
heart. Statins will be given for high cholesterol and there will be pills for
hypertension. They’re developing a “poly-pill” so all these medications will
be in one pill (will be good with complacency because some old people
don’t like taking their medications).
- Angioplasty if they think you have blocked arteries or a heart attack
they will do an angioplasty. A catheter is sent up the grown to the heart
and there is a balloon that is inflated to remove a blockage in an artery. It
is 90% effective and cuts the risk of people having heart attacks.
Unfortunately many people are back within 6 months because they don’t
change their lifestyle. - Coronary Stents if the angioplasty doesn’t do the job in terms of
opening up the arteries or particularly in the neck area they will send metal
stents up that will hold the artery open for the rest of your life
- Coronary Bypass if you’ve had a heart attack (because of a blocked
artery) they will do a coronary bypass and it is very invasive. A vein is
taken from your leg and the blocked area is rerouted using the leg vein.
**It takes about a year for someone to fully recover from their surgery.
They found a third of people stopped taking their medications within the
year. Also a lot of people just never even fill their prescription because
they don’t feel like it or the medications are too expensive
- Blood Pressure 120/80 to 139/89 is called pre-hypertension. These people
should consider themselves to have high blood pressure
140/90 or above is hyper tension
-30 Canadians die today due to too much salt intake.
- Risk Factors major risk factor is salt intake. This has been recognized in the
past 5 years that as one ages, the body has less of an ability to deal with sodium
and it raises blood pressure. Because of too much salt, the heart also retains
fluid and has to pump harder. One out of 8 cardio-events are due to too much
salt. Canadians are the highest consumers of salt in the world. All our products
have more salt in them (eg. Kellogg’s or Burger King in Canada). The quota of
salt per day should be one piece of pizza. The Canadian Medical Society is
going to start a war on salt and suggests that Canadians should only have one
teaspoon of salt or 5 g of salt a day.
White coat syndrome: blood pressure goes up
Everyone should do it , it helps you regularly check up
- Prevalence more prevalent today than it was 5 years ago. There are more
people on medications for high blood pressure. Hypertension has no symptoms
and unless you get it tested you really don’t know.
- Treatment diet advocated is the DASH diet, which stands for Dietary
Approaches to Stop Hypertension. The DASH diet is very good, doctors will
recommend it (usual healthy di